Forgotten Vaginal Pessary
S nidhi, K Dahiya
Citation
S nidhi, K Dahiya. Forgotten Vaginal Pessary. The Internet Journal of Gynecology and Obstetrics. 2009 Volume 14 Number 2.
Abstract
A foreign body in the vagina is quiet common in children but is rare in adults. We report a case of forgotten vaginal pessary detected 30 years after its insertion in an 80 year old lady. A review of the relevant literature was undertaken and the associated complications were noted.
Introduction
Pessaries were used for the treatment of prolapse and are still used in elderly patients who carry a poor operative risk. A forgotten vaginal pessary is a rare entity now-a-days. Sometimes the pessary gets incacerated and has granulation tissue which makes its detection and removal difficult. Most women present with a malodours discharge. There have been cases of carcinoma developing due to the chronic irritation caused by the pessary
Case Report
An 80 year old lady presented to the outpatient department with chief complaints of a discharge per vaginum. The discharge was blood stained and foul smelling. On history a provisional diagnosis of carcinoma cervix was made. On per speculum examination a rim of the impacted pessary was seen. It was surrounded by granulation tissue and there was foul smelling discharge. On further interrogation the patient recalled a pessary being inserted 30 years back for uterine prolapse. An examination under anaesthesia was done and the pessary was removed after removing the surrounding granulation tissue. There was slight oozing of blood from the vaginal bed which stopped on pressure packing. She was discharged after a short course of antibiotics and a paps smear was taken a week later. The report of the smear was normal.
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Discussion
There have been various case reports of forgotten foreign bodies in children (1,2) but fewer in adults(3,4,5,6).
Various complications have been reported with retained pessary in adults including fistula formation, bowel obstruction, malignant change. Vaginal pessaries are made of different materials (rubber, clear plastic, silicone, soft plastic). Russel reported seeing patients with complications such as rvf, vaginal cancer, or chronic vaginitis (7). Other complications are incareration, ulceration, metaplasia, intestinal obstruction , urosepsis and hydronephrosis. Jain et al reported two cases of vaginal cancer due to forgotten pessary.
It is important to bear in mind that a forgotten pessary may be the cause of foul smelling discharge in an old lady. Such women often fail to follow up and develop some complication. These forgotten foreign bodies should be removed under adequate sedation and underlying malignancy should always be ruled out.